Considering prescribing HRT?

[Papermate44]

I’ve started to go down a rabbit hole of perimenopausal/menopausal symptoms and treatment. This topic was not discussed much in medical school, (obviously not my training in anesthesia). Every month there’s new literature that comes out that fascinates me. It’s made me wonder if these mid 40 year olds with fibromyalgia type symptoms should try progesterone/estradiol replacement therapy to see if it helps their symptoms. Perimenopause and fibromyalgia seem almost identical in presentation it seems….

Thoughts on starting to prescribe HRT to these types of patients?

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[clubdeac]

Test supplementation indisputably decreases pain, regardless of insufficiency

 

[Papermate44]

Test supplementation indisputably decreases pain, regardless of insufficiency

That’s a whole other beast that I have not yet read much about.

 

[Ducttape]

there is very little literature out there that looks at HRT for fibromyalgia. i jsut did a search and found 1 article that was positive, 1 not.

positive:

Fibromyalgia and menopause: an open study on postmenopausal hormone therapy - PubMed

HT improving sleep and quality of life in both groups; it was a significant clinical improvement seen by FIQ and FS in FM patients. These changes characterize improvement of functional status and symptoms severity.

pubmed.ncbi.nlm.nih.gov

negative:

Hormonal replacement therapy does not affect self-estimated pain or experimental pain responses in post-menopausal women suffering from fibromyalgia: a double-blind, randomized, placebo-controlled trial - PubMed

ClinicalTrials.gov Registration; http://www.clinicaltrials.gov; NCT01087593.

pubmed.ncbi.nlm.nih.gov

there is increasingly more evidence that fibromyalgia may be more immunologically related, and hormonal therapy may be something to consider.

should be studied more. of course, there are risks to HRT therapy...

 

[lobelsteve]

Not my job

 

[Baron Samedi]

Not my job

Agreed, and a whole mess of liability I want nothing to do with.

 

[Agast]

Are you looking for justification to start billing cash for putting testosterone pellets in women’s’ butts? Because there are already pain doctors doing that. Cash pay makes everything seem so reasonable

 

[sloh]

Are you looking for justification to start billing cash for putting testosterone pellets in women’s’ butts? Because there are already pain doctors doing that. Cash pay makes everything seem so reasonable

A whole lot of physicians in general doing that haha. Saturated

 

[Doctodd]

the FP doc does it near me

 

[au bon pain]

If you’re looking for an ancillary, start offering suboxone for OUD. More proximate to our training/field than HRT, solid evidence, and you’ll do more for those patients and society.

 

[kstarm]

I guess maybe some overlap with symptoms but fibro vs menopause seem different enough to me. I agree that their is more and more compelling evidence that immune interactions with the nervous system leads to fibro et al symptoms and there is likely some role for immune modulation for that group though definitely not clear exactly what. I am no way an expert on menopause but what I have come across seems like HRT can definitely be helpful, and that the risks may be overstated. There is also good evidence for management of hot flashes with hypnosis which is often one of the more disabling symptoms.